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A Balancing Act: Oncologist Explains the Impact of Physician Administrative Burdens

Surabhi Dangi-Garimella, PhD
At the annual meeting of the American Society of Clinical Oncology, Robin Zon, MD, discussed the growing administrative burdens in oncology practice with the movement towards value-based payment.
One of the first sessions offered at the annual meeting of the American Society of Clinical Oncology (ASCO), held at the McCormick Convention Center, Chicago, May 29-June 2, 2015, included a discussion on the growing administrative burdens in oncology practice. During the session, Robin Zon, MD, FACP, FASCO, a practicing medical oncologist from Michiana Hematology Oncology, PC, discussed the time and resources utilized by physicians and the practice staff as they struggle to balance administrative burdens with clinical care.
 
Physicians often complain about the increasing requirements to record and maintain metrics, especially now during the transition to value-based payment models. Clinicians say the requirements siphon off vital resources from practices that are already stretched too thin.
 
In her talk, “Growing Concern of Administrative Burdens in Practice,” Zon defined administrative burdens as “costs imposed on businesses, when complying with information obligations stemming from government regulation”—a definition provided by the Better Regulation Unit.1 
 
However, said Zon, no oncology-specific database provides this information, even though many oncologists are distressed by this burden. The State Affiliate Council, an advisory group to ASCO’s board of directors, through its Dashboard initiative (launched in September 2014), surveyed oncologists about how prior authorization requirements from payers are affecting their practices. A majority said the requirements demand increasing amounts of staff time, cause employee dissatisfaction, and do not seem to improve clinical outcomes.
 
“Will prior authorization have any effect on clinical decision making?” Zon asked.
 
Prior authorization is just one of the time-consuming burdens that practices face. When surveyed on the number of clinical pathways that practices have to follow—either payer-implemented or developed in-house—several responders said they had between 5 and 8 different clinical pathways in their practice, a majority of which were payer-initiated.
 
“Pathways are here to stay,” said Zon, “but they need to be improved and they need to change over time.”
 
The transition from volume to value is another important change in the healthcare industry that is increasing the documentation requirements for physician practices. Thomas Gallo, MS, said at an Association of Community Cancer Centers meeting that in an attempt to collect data, which is the backbone of value-based programs, smaller practices are merging with bigger ones.
 
Citing a recent article in the New England Journal of Medicine2 by HHS secretary Sylvia Burwell, Zon said that the government is focused on transforming our healthcare system through value-based payment goals. But pursuing these goals will all increase the physician and practice requirements for documentation.
 
“A 2008 survey by 2 internists found that the average doctor spends 8.7 hours per week and 1.7 hours per day on administration, which averages to 16.6% of their working hours,” said Zon. So 4720 physicians surveyed in the study spent about 168.4 million hours on administrative duties, resulting in lower career satisfaction.3 The authors predict that in 2014 the total cost of physician time spent on administrative duties will amount to $102 billion.3
 
“This means a decrease in the number of hours that we spend in doing what we are supposed to do, which is patient care,” said Dr Zon. “I think this would result in disastrous outcomes.”
 
“To deliver the highest quality and highest value care to patients, we need a collaboration among payers, providers, industry, patients, and employers.”
 
 

References

1.      Administrative burdens. Better Regulation website. www.bru.gov.mt/administrative-burdens. Accessed May 29, 2015.

2.      Burwell, SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897-899.

3.      Administrative work consumes one-sixth of U.S. physicians’ time and erodes their morale, researchers say [press release]. http://www.pnhp.org/news/2014/october/administrative-work-consumes-one-sixth-of-us-physicians%E2%80%99-time-and-erodes-their-mor. Chicago, IL: Physicians for a National Health Program; October 23, 2014.
 
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